Quality standard

Quality statement 5: Risk assessment – smoking cessation

Quality statement

Pregnant women who smoke are referred to an evidence-based stop smoking service at the booking appointment.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements that pregnant women have their smoking status recorded at the booking appointment.

Data source: NHS Digital's Maternity Services Data Set collects data on smoking status at the booking appointment.

b) Evidence of local arrangements to ensure that pregnant women who smoke are referred to an evidence-based stop smoking service.

Data source: Local data collection.

c) Evidence of local arrangements to ensure that pregnant women who smoke and decide not to attend an evidence-based stop smoking service receive follow-up.

Data source: Local data collection.

Process

a) Proportion of pregnant women accessing antenatal care whose smoking status is recorded at the booking appointment.

Numerator – the number in the denominator whose smoking status is recorded at the booking appointment.

Denominator – the number of pregnant women accessing antenatal care.

Data source: NHS Digital's Maternity Services Data Set collects data on smoking status at the booking appointment.

b) Proportion of pregnant women who smoke who are offered a referral to an evidence-based stop smoking service.

Numerator – the number in the denominator who are offered a referral to an evidence-based stop smoking service.

Denominator – the number of pregnant women accessing antenatal care who smoke.

Data source: Local data collection.

c) Proportion of pregnant women who smoke who are referred to an evidence-based stop smoking service.

Numerator – the number in the denominator who are referred to an evidence-based stop smoking service.

Denominator – the number of pregnant women accessing antenatal care who smoke.

Data source: Local data collection.

d) Proportion of pregnant women who smoke and decide not to attend an evidence-based stop smoking service who receive follow-up.

Numerator – the number in the denominator who decide not to attend an evidence-based stop smoking service who receive follow-up.

Denominator – the number of pregnant women who smoke and decide not to attend an evidence-based stop smoking service.

Data source: Local data collection.

Outcome

a) Quit rates for pregnant women.

Data source: Local data collection. NHS Digital's statistics on NHS Stop Smoking Services in England includes quit rates for pregnant women who set a quit date.

b) Smoking rates in pregnancy.

Data source: NHS Digital Statistics on women's smoking status at time of delivery: England collects data on smoking status at the time of delivery.

What the quality statement means for different audiences

Service providers ensure that systems are in place to ensure that all pregnant women who smoke are referred to an evidence-based stop smoking service at their booking appointment.

Healthcare professionals refer all pregnant women who smoke to an evidence-based stop smoking service at their booking appointment.

Commissioners ensure they commission services which refer all pregnant women who smoke to an evidence-based stop smoking service at their booking appointment.

Pregnant women who smoke are referred to an evidence-based stop smoking service at their booking appointment.

Definitions of terms used in this quality statement

Advice on smoking cessation

Advice should be first provided at the booking appointment and when appropriate throughout the period of antenatal care. The midwife may provide the pregnant woman with information (in a variety of formats, for example a leaflet) about the risks to the unborn child of smoking when pregnant and the hazards of exposure to second-hand smoke for both mother and baby.

Women who smoke or have recently quit smoking should be referred to an evidence-based stop smoking service if:

  • they say they smoke, or

  • they have a carbon monoxide (CO) reading of 7 ppm or above, or

  • they say they have quit smoking in the past 2 weeks, or

  • they say they are a light or infrequent smoker but register a low CO reading (for example, 3 ppm).

[Adapted from NICE's guideline on smoking: stopping in pregnancy and after childbirth]

Evidence-based stop smoking services

Local services providing accessible, evidence-based and cost-effective support to people who want to stop smoking. The professionals involved may include midwives who have been specially trained to help pregnant women who smoke to quit (NICE's Pathway on stop smoking interventions and services).

At the time of referral, the pregnant woman should be given the number of an evidence-based stop smoking service. This may include the number of the NHS Smokefree helpline (0300 123 1044), details of the NHS quit smoking webpage and a number for a local helpline if one is available.

[Expert opinion]